Healthcare Provider Details

I. General information

NPI: 1497005953
Provider Name (Legal Business Name): AT HOME CARING ANGELS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 SMALL FARM RD
MUKWONAGO WI
53149-1466
US

IV. Provider business mailing address

749 SMALL FARM RD
MUKWONAGO WI
53149-1466
US

V. Phone/Fax

Practice location:
  • Phone: 414-587-3428
  • Fax:
Mailing address:
  • Phone: 414-587-3428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE C ZMUDZINSKI
Title or Position: OWNER
Credential:
Phone: 414-587-3428